This PPT demonstrate a very useful review related to the evidence based prospection of switching platform in dental implants.

1. Evidence Based Prospection Of
Switching Platform in Dental Implants
Ziad S. Abdul Majid BDS, Dip.Imp.Dent
May / 2015

2. In an attempt to improve long-
term bone maintenance around
implants, an implant-to
abutment connection referred to
as “platform switching” has been
proposed.
Overview

3. The Implant Abutment Interface
The “ MICROGAP “
• The connection between implant fixture
and its restorative abutment is termed the
implant abutment interface (IAI) or
“microgap”.
• In most cases, it is susceptible to
micromovements during clinical function
and also permits micro-leakage of fluids,
this infiltration results in the permanent
presence of an area of abutment
inflammatory cell infiltrate .
• The sustained state of inflammation
promotes osteoclast formation and
activation, which contributes to bone loss
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent
2006;26:9–17.

4. (Lindhe et al., 1992) “ Evaluated the microgap of the
Brånemark 2-stage implant and found inflamed
connective tissue existed 0.5 mm above and below the
abutment-implant connection, which resulted in 0.5 mm
bone loss within 2 weeks after the abutment was
connected to the implant ”.
Microgap and The platform-switching concept
Lindhe et al., Clin Oral Implant Res1992;3:9-16.

5. Factors Contributing to Marginal Bone Loss Around
Implants
The remodeling process involves
marginal bone resorption that is
affected by the following factors:
1. Infectious process.
2. Excessive loading conditions.
3. The location, shape, and size of the
implant-abutment microgap and its
microbial contamination.
4. Biologic width geometry and
implant surface roughness.

6. 5. Peri-implant inflammatory
infiltrate.
6. Micro-movements of the
implant and prosthetic
components.
7. Repeated screwing and
unscrewing.
8. Implant-neck.
9. Traumatic surgical technique.
Chrcanovic, Bruno Ramos et al. Platform switch and dental implants: A meta-analysis.Journal of Dentistry 2015

7. The concept of platform switching
was introduced by Lazzara and
Porter 2006:
• the use of a smaller-diameter
abutment on a larger-diameter
implant collar. Through the
placement of smaller
prosthetic components on the
implant platform, the implant-
abutment junction is moved
inward from the implant
shoulder and further away from
the bone, shifting the
inflammatory cell infiltrate to
the central axis of the implant
and away from the adjacent
crestal bone.
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent
2006;26:9–17.

9. - It was suggested that the inward
positioning of the implant-abutment
interface allowed the biologic width to be
established horizontally, as an additional
horizontal surface area is created for soft
tissue attachment.
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent
2006;26:9–17.

10. - Less vertical bone resorption is
required to compensate for the biologic
width.
- This design increases the distance
between the inflammatory cell infiltrate
at the microgap and the crestal bone,
thereby minimizing the effect of
inflammation on marginal bone
remodeling.
Lazzara RJ, Porter SS. Platform switching: A new concept in implant dentistry for controlling postrestorative crestal bone levels. Int J Periodontics Restorative Dent
2006;26:9–17.

11. • The mechanism by which platform
switching can contribute to
maintain the crestal bone height
could be due to four reasons:
1. Shifting the inflammatory cell
infiltrate inward and away from the
adjacent crestal bone.
2. Maintenance of biological width
and increased distance of IAJ from
the crestal bone level.
How platform switching reduces crestal bone loss ?
Peri-implant bone level around implants with platform-switched abutments. Fickl, S et al. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:577–
581

12. 3. The possible influence of
micro-gap on the crestal bone
is diminished.
4. Decreased stress levels in
the peri-implant bone.
Peri-implant bone level around implants with platform-switched abutments. Fickl, S et al. INT J ORAL MAXILLOFAC
IMPLANTS 2010;25:577–581

13. Benefits Of Platform Switching
1. Increased implant longevity.
2. Improved esthetics.
3.The effect of inter-implant
distance is minimized. “ A
minimum of 3 mm inter-implant
distance is needed to preserve
marginal bone”.
Serrano-Sánchez P, Calvo-Guirado JL, Manzanera-Pastor E, Lorrio- Castro C, Bretones-López P, Pérez-Llanes JA. The
influence of platform switching in dental implants. A literature review. Med Oral Patol Oral Cir Bucal. 2011 1;16 (3):e400-5.

14. Limitations Of Platform Switching
1. If normal sized abutments are to
be used, implants of larger size
need to be placed. This might not
be possible always clinically.
2. If normal implants are to be
used, smaller diameter abutments
may compromise the emergence
profile in aesthetic areas.
Serrano-Sánchez P, Calvo-Guirado JL, Manzanera-Pastor E, Lorrio- Castro C, Bretones-López P, Pérez-Llanes JA. The
influence of platform switching in dental implants. A literature review. Med Oral Patol Oral Cir Bucal. 2011 1;16 (3):e400-5.

15. 3. Around 3 mm of soft tissue
should be present to place platform
switched implants or else bone
resorption is likely to occur.
4. For platform switching to be
effective, the under sizing of the
components must be carried out
during all phases of the implant
treatment.
Serrano-Sánchez P, Calvo-Guirado JL, Manzanera-Pastor E, Lorrio- Castro C, Bretones-López P, Pérez-Llanes JA. The
influence of platform switching in dental implants. A literature review. Med Oral Patol Oral Cir Bucal. 2011 1;16 (3):e400-5.

16. In Brief Platform switching
• Capable of reducing or eliminating crestal bone loss. It also
contributes to maintaining the width and height of crestal bone
and the crestal peak between adjacent implants and it also
limits the circumferential bone loss.
• Offer multiple advantages and potential applications, which
include situations where a larger implant is desirable but the
prosthetic space is limited, and in the anterior zone where
preservation of the crestal bone can lead to improved
aesthetics.

17. Thank you